What I’m going to tell you now is something that I wish someone would have told me 12 years ago during my third year of medical school. I’d probably be a mega-millionaire now but I suppose I wouldn’t have gained the experiences that have led me toward my path of true financial freedom.
I’ll start by telling you a little bit about me. I’ve always been torn between my passion toward medicine and my passion toward the arts. This actually drove me to take a year leave of absence after finishing my second year of medical school. I went back to college and took every non-science class I could: drama, jazz music, creative writing, and the great fictional works of the 20th century. I even joined the university’s women’s lacrosse team. I then “studied” abroad in Europe-basically a pseudonym for party and travel as much as you can for five months before heading back to medical school.
Did I want to return home? Of course not, but at the time, I felt I had no choice but to finish what I had started. It had been hammered into me that the only approved professions in life were being a doctor or a lawyer. My mother always told me that since I was a girl, I probably wouldn’t succeed in other fields. I’m not sure where she was coming from, but you can see the environment that I was being raised in.
I spent the next two years of medical school trying to figure out what specialty I could go into that would intertwine medicine with the arts. Believe me, this was quite a stretch, but I settled on family practice as I figured it would allow me the greatest flexibility in my future endeavors. I pictured myself teaching a class of patients how to cook zesty low fat meals, or instructing a whole bunch of postmenopausal hot-flashers how to downward dog or tree pose in order to control their rising chi. Ok, I did preface this by saying it was a stretch.
Skip five years into the future. I had settled into a small practice in Arizona as a physician employee, was a month into my maternity leave with my firstborn son, when my employer told me that he was closing his practice and becoming a hospitalist as running the business was too stressful and the monetary rewards were not lucrative enough. I was told that I would have three months to find another job or I could buy his practice. I remember being stressed-here I was a first time mother just figuring out how to bathe an infant and I was being told to job hunt or run my own medical practice? I took a look at my employer’s numbers, and the data was not promising. His overhead costs were approximately 60% of his total revenues. On the other hand, the outside job options at the time were not appealing. Sure, I’d earn $180,000, but I’d have to see twenty-some patients per day and there would be no time in my practice to do acupuncture, something I had trained six months to do.
Call me plain postpartum crazy or maybe desperate, but I chose to learn how to run my own practice because I still wanted to do things my way. I spent the next year figuring out how to earn a multiple six-figure income seeing only sixteen to seventeen patients per day and allowing forty-five minutes for physicals. I only worked four days a week, never scheduled a patient past 4:30 pm, didn’t do OB or round on patients in the hospital.
Wow, you’re thinking. Is this what she’s going to divulge? How to earn over $200,00 barely working? Unfortunately, this is not where it gets good. That comes a bit later in the story. This is however a part of the story where I will pause and tell you, running your own brick and mortar business is very difficult. No one in medical school or residency instructs you how to find the best vendors or set up your own LLC. You don’t get trained to fight with insurance companies to reimburse you an extra 3% when you’re in private practice. Yes, you learn in school how to bill a level IV office visit correctly, but you don’t learn how to use modifiers so that you get paid your measly ten dollars to do an ear lavage, or what to do when an insurance company denies your claim, or how to set up an IRA plan for your employees. No one ever tells you what to do when you’re on the other side of the country and suddenly find out that one of your new employees has been secretly prescribing narcotics for themselves and their friends with your DEA number. Or, how to go about getting someone to cover you for two months while you’re on maternity leave for the second time and this time it’s your business and you’re still responsible for making sure it’s running smoothly without you physically being there. I was working only four days a week, but running a business was itself more a full time job. I realized a few months before my second child was born, that there was no way I would be able to spend enough quality time with my growing family doing both jobs.
So, I too closed my practice with many regrets. I said goodbye to my family of loyal and hardworking employees (minus the narcotic nutcase) that I had personally hired. I was saying goodbye to the autonomy of solo practice. I must say however that I was truly glad that someone else would be taking care of my coding and billing, of insurance contracts, of building maintenance, of ordering supplies and shredding confidential documents, of payroll…the list goes on and on.
Working for someone else comes with a price: you pay for someone else to run a practice. My overhead was double that of my previous practice, so I HAD to see at least 5-7 more patients per day in order to take home just two-thirds of my previous income. As a result, I had less time to spend with my patients, I stopped doing acupuncture because of its low reimbursement, I had more paperwork than ever before, and it seemed like I only saw my family on weekends.
I tolerated this lifestyle for about six months…and maybe I should say that I THOUGHT I tolerated this lifestyle, because physically my body fell apart. At the time, I didn’t realize why I was getting sick all the time. I thought it was because I now had two children going to daycare and picking up germs. I thought that my insomnia and persistent tension headaches were due to staring at a computer screen all day (the new office had an electronic health record system). I took ibuprofen on a daily basis for neck and back pain I assumed was from a poor ergonomic work set-up and the fact that I had no time at all to exercise. I was congratulated time and time again on my rapid weight loss that I took for granted as being from breast pumping three times a day all while eating and typing my progress notes between visits.
Had I had a doctor, he or she would have told me within five minutes of discussing my symptoms that I was depressed, but it took me six months to self-diagnose my depression. Once the realization hit, I was forced to contemplate my future. Either take an antidepressant in order to function or take control of my life. I’ve always believed in the power of antidepressants as I prescribe them all the time, but I knew in my heart that it made no sense to take a pill in order to treat depression brought on by something I could change. I could either cut down my days at work and take a further reduction in salary, or cut down my workdays and try to supplement my income in other ways.
OK, if you’ve been skimming most of the above passages, now’s the time to start reading this part VERY CAREFULLY. Most of us have spent much of our adult life buried in our books and setting short term goals: Graduating top of our class in high school, graduating near the top of our class in college, being thankful to graduate in the top half of our class in medical school, crying with joy when we’ve finished our intern year, cruising through the rest of residency, and finally finding our first jobs that offers an unbelievable salary and lifestyle compared to that in residency. We think at this point that we’ve got it made, that life is good, and that it’s finally time to relax after all the years of schooling and all-nighters. Some of us make more than others, but for the most part, there’s a certain income level that we all believe we are worth. Most would agree that the number ranges between $150-300K across all specialties. Most of us would also agree that those earning the higher end of the income spectrum are working full-time, and it’s only fair that part-timers make half that. About six months ago when I was thinking about going part-time I’d be thrilled if I could still make a six-figure income. Agreed?
Back to where I left off about the part where I began researching ways to supplement my income while working part-time. At first, I was thinking I’d find ways to make an extra $30,000 or so from home. I had a close friend that had badgered me about joining her MLM (multilevel marketing) scheme for three years. I was always hesitant as she never seemed to have any money, and most of these MLM opportunities involved me talking to and trying to convince friends and family members to join. Well, most of my family live overseas, and I had been busy running a successful practice and raising two kids for several years, so I could probably count the number of friends in Arizona I had made on one hand. I also didn’t feel comfortable with all the compensation number jargon this friend kept throwing out, something like “if you put in $400 to join, then you get your five and five then you start making 10% of what they bring in but only if they bring in a two and two…” I seriously never understood the compensation plans even though they were explained in deceivingly simple arrow diagrams oh yeah with multiple rows of small writing underneath prefaced with asterisks.
I happened to come across an ad for a marketing business while Googling “MLM scams.” The ad explained that this home-based business was turn-key, it did not involve cold-calling or selling to friends and family, it was not an MLM, and there was a potential to make $250,000 or more your first year. Actually, the company founder, a multimillionaire, stated that his goal was to create another 100 millionaires by the year 2012. Although this hype seemed like another hoax, I couldn’t help but wonder how I could “Make more than your doctor in the next three months!” After a few weeks of painstaking research on the company and its business model and practices, I decided to take the plunge and join in. To be honest, it has been at times overwhelming learning new skills such as Google AdWords or setting up a landing page, but it’s no more difficult than gross anatomy. You just start dissecting away and follow instructions until you get through the first layer, then go back and dissect some more until you’ve got a clear picture of what’s going on.
I have since reduced my medical practice hours further to 3 days a week, and it’s fantastic to be able to schedule a lighter patient load knowing that the income I earn is secondary to what’s become my primary online marketing business. Going to work is fun again and no, it’s not because I’m taking an antidepressant. I’m earning money from this business even when I’m seeing patient, and I can take my business with me on vacation anywhere in the world. I have more time with my family and I’m exercising again. There’s peace of mind knowing that I could retire in the next five years if I chose to do so, but why would I when my passion’s been ignited again toward medicine and I feel good knowing that I’m providing quality care to others. Don’t ever forget that no matter how much money you make in your lifetime, your only source of true and sustaining happiness will come from what value you provide to those around you. Isn’t that why we went into medicine in the first place?
Good luck to all of you. I hope that I’ve helped some of you realize that you’ve got to start thinking about work life balance. Many of you are probably single and still in medical school or in residency, but you’ve got to realize that you will be faced in the not too distant future with the challenges of being a great physician as well as a great spouse and parent. You are going to have to figure out whether you’re willing to sacrifice your time for money or your family or even your own health. You’ve got to dig deep and question whether or not you want someone else dictating to you much your are worth, or whether you’ve got the guts to take control of your life and financial wealth by starting your own business.
Tags: college, health, medical, medical school, money, school, university